Inspection on 25/02/09 for Heatherdale Residential Home

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heatherdale Residential Home 26/02/07

Heatherdale Residential Home 06/12/05

Heatherdale Residential Home 06/05/05

Heatherdale Residential Home 24/11/04

Heatherdale Residential Home 28/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heatherdale Residential Home Heatherdale Residential Home South Broomhill Morpeth Northumberland NE65 9RT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Malloy     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Heatherdale Residential Home Heatherdale Residential Home South Broomhill Morpeth Northumberland NE65 9RT 01670-760796 01670761889 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellburn Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 36 Number of places (if applicable): Under 65 Over 65 0 36 dementia old age, not falling within any other category Additional conditions: 15 0 The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 36 Dementia - Code DE, maximum number of places: 15 Date of last inspection Brief description of the care home Heatherdale is a care home that is located in South Broomhill, within reach of shops and other local amenities. The home provides personal care and support to 36 older people including 12 older people with dementia. It is equipped with a passenger lift. All bedrooms are single and 24 rooms have en-suite facilities. Communal lounge and Care Homes for Older People Page 4 of 31 Brief description of the care home dining areas are provided. There are baths and showers, and separate toilets. The home has car parking space and accessible attractive gardens. A guide to the homes services and inspection reports are readily available at the home. The current weekly fees range from £443.00 to £464.43 for residents who are either privately funded or funded by the Local Authorities. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. The inspection was carried out by: Looking at information received since the last key inspection on 26th February 2007. Getting the providers view of the service and how well they care for people. An inspector visiting the home on 25th February 2009. Care Homes for Older People Page 6 of 31 Talking to the manager and other staff about the service. Looking at records about the people who live at the home and how well their needs are met. Looking at a range of other records that must be kept. Checking that staff have the knowledge, skills and training to meet the needs of the people they care for. Looking at the resources that the home has to operate the service. Getting the views of people living at the home and staff by talking to them, and from surveys they completed. Checking if improvements recommended at the last inspection have been made. The inspection was carried out over seven and a half hours. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Each new person should have his or her needs assessed before moving into the home to make sure their care can be properly planned. Staff are to make sure that medication records are always properly completed. Care Homes for Older People Page 8 of 31 Recruitment details need to include a record of interview and a statement that the person is fit to do the job, to show that staff are suitably vetted. An experienced and qualified person needs to apply to become the Registered Manager for the home. While methods are used to monitor the quality of the service, these are still to be set out in an annual plan with clear aims for what is to be achieved. Health and safety must be better promoted by giving staff regular fire safety instructions and testing the fire alarms every week. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not consistently assessed before they move into the home so they cannot be assured of having their care properly planned. Evidence: At the last inspection the home was required to ensure that an assessment of each persons needs is completed before admission. The admission process was discussed with the acting manager. She said that when an enquiry is received the person is invited to visit and spend time at the home. Assessment information is obtained from the care manager, where the persons placement is to be funded by a Local Authority. Where applicable, information is also provided by health care professionals. The homes own pre-admission assessment of care and support needs is usually carried out when the person visits the home, or in their own home. The records of the last two people admitted showed that one person had their needs Care Homes for Older People Page 11 of 31 Evidence: assessed before moving in but their initial care plans did not reflect all identified needs. The plans have since been updated. The other persons assessment was not completed until after admission. A checklist is used to record that information about the service, and orientation to the home has been provided to people when they are admitted. This includes giving people a brochure and welcome pack and introducing them to other people living at the home and staff. People told us that they received enough information about the home before they moved in, so they could decide if it was the right place for them. A relative said her mothers respite stays at the home had helped her to decide to move in permanently. Another relative said her mother has settled in very well and is making friends. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good support to meet their health and personal care needs and care is planned in a sensitive manner. Evidence: The home uses a variety of assessment tools to identify individuals health and personal care needs. They are updated at least every six months to reflect current needs and dependency. Care records showed that people have generally well recorded, personalised care plans. The plans are set out into the persons strengths and needs and show the support staff provide and what the person can do independently. They addressed physical and mental health, personal care, hygiene, social and spiritual needs. There was evidence of plans being updated as a result of changing needs and advice from medical professionals. Care plan evaluations had lapsed and were not completed monthly, though staff are bringing these records up to date. Changes are being made to the homes key worker system, and the manager said people are being informing of their allocated key Care Homes for Older People Page 13 of 31 Evidence: worker. The majority of staff told us they are always given up to date information about the needs of the people they support and that the ways information is passed between staff usually works well. One staff member said, There are good care plans in place for staff to look at, at any time. We all have a hand over so we can discuss any problems or if peoples needs have changed. People living at the home told the inspector that they receive good care to meet their needs. One person said, Nothing is too much trouble for the staff. A relative said, My mother is well looked after and feels safe here. The family are happy, and say it is a lovely home. People who completed surveys said they always or usually receive the care and support they need. Two people made comments about staff being busy. One said, You hesitate to make any demands on them, and another said, My mother feels that sometimes they are too busy to give full attention. People have their health care needs assessed and care planned. Plans are in place to meet needs such as mobility and moving and handling, pressure area care, continence, nutrition, and mental health and behaviour. Most people told us they usually receive the medical support they need. One person said nurses from the local surgery have been very supportive. Records are kept of all visits by professionals including doctors, district nurses, physiotherapist, optician, dentist, chiropodist and hospital appointments. One GP practice is used. This is a local health centre and a doctor visits people living at the home weekly. The district nursing service was currently visiting patients daily. People with mental health frailty receive psychological care from a consultant psychiatrist and community psychiatric nurses. Staff at the home monitor individuals well-being and behaviour to give feedback to mental health professionals. Weights are checked at least monthly. People with poor appetite or weight loss have care plans to meet their nutritional needs. The plans state where dietary supplements are prescribed, the persons favourite foods, and how often weight is monitored. The cook and five staff have recently done nutrition training. The manager said people are offered sherry at lunch time to stimulate appetite and snacks are provided between meals, such as cake with afternoon drinks. Risks according to individual vulnerability are assessed and steps are taken to minimise or manage identified risks. The assessment includes risks associated with sensory impairment, medication, smoking, going out alone, mental health, finances, making hot drinks, bathing, transport, and night checks. A separate assessment of risk of falls is completed. Care Homes for Older People Page 14 of 31 Evidence: The home has a medication policy and procedures. The manager and team leaders only deal with medication and all have had relevant training. Medication records showed that each person has a photograph for identification purposes. Pre-printed medication charts are provided by the pharmacist and hand written directions were clear. The majority of charts were appropriately recorded with staff signatures to verify medication given and codes used to state the reason why medication was not given. A few gaps to signatures were noted, the majority of which were for prescribed nutritional supplements. There was also 13 signatures recorded for a course of 12 antibiotics. The medication system is audited on a monthly basis. Privacy and dignity issues are built into individual care plans to guide staff on how to support people in a sensitive way. People told the inspector that staff respect their privacy and dignity. The preferred name that each person wishes to be addressed by is recorded in their care file. The manager said that personal care and treatment is carried out in the persons bedroom. Consultation with health care professionals was discussed. The manager will make sure this takes in private. All single bedroom accommodation is provided and the majority of rooms have ensuite facilities. People are offered keys for their bedrooms and can personalise and equip their rooms as they choose. The home will assist people to have a telephone installed. Two people have their own telephones with direct numbers. Post is given directly to people and staff or relatives provide support with dealing with correspondence if needed. There are dedicated laundry staff and each person has their own laundry basket. Clothing is name labelled to make sure it is returned to the correct person after laundering. Some relatives take washing home to do and take items to be dry cleaned. The home provides services to people of different age, gender, disability, religion and beliefs and is committed to ensuring that people are respected as individuals with diverse needs. The provider has made equality and diversity training mandatory to give staff improved understanding of peoples diverse needs and rights. The equality and diversity policy has also been issued to all staff. Most staff said they feel they always have the right support, experience and knowledge to meet the different people who use the service. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to live their preferred lifestyle and are offered plenty of choice of activities, community contact and meals to meet their social and dietary needs. Evidence: People are asked about their preferred routines and social interests and have individual social care plans. Staff are working with people and their relatives to get information on individuals background and history so they can record social profiles. Most people said there are always or usually activities arranged by the home that they can take part in. Comments included, I really like doing the exercises, There is always something going on, so I choose what I want to be involved in, and, Its nice to be sociable again, I enjoy the company of other people and the staff are good fun. One staff member currently takes responsibility for organising and monitoring activities in the home. There is a monthly forward planned programme of activities and people are given a copy for their information. Two or three sessions of activity take place most days. The programme showed a very good range of activities, events and outings is provided. This includes various games and quizzes, reminiscence and memory sessions, movement to music, films, hymn singing, facials and manicures, Care Homes for Older People Page 16 of 31 Evidence: and discussion on local news. There are weekly visits from a lady who does armchair exercises and another lady provides hand and foot massages with oils. Events and special occasions are celebrated and themed days are planned. This month there was a St Valentines party with an entertainer and staff dressed in red clothing. There was also a visit from a person who brought various animals and insects into the home for people to experience. People told the inspector this was a different and stimulating activity that they would like to have again. A file is kept of photographs and details of social events. The recommendation made at the last inspection to improve recording of activities provision, and develop more activities suitable for people with dementia has been followed up. A diary is completed each day and records showed the types of activities provided, names of people taking part and comments on whether they enjoyed the session. Some people commented that staffing constraints mean they cant have one to one time with individuals. This is now built into the activities programme and was evident from entries to the social diary. There is an open visiting policy and people are encouraged to maintain contact with family and friends. People are offered regular contact with the community. There are weekly trips to the Friendly Cafe in Amble and every two weeks to the Tuesday Club in Hadson, where different activities take place. Additional small group outings are also organised. The home has its own car and also uses taxis with wheelchair access as transport for people. There are links with a local school and church, and members visit the home, usually for seasonal events. The manager said people are supported to retain their independence and are offered choices in daily living. People confirmed they are offered choices and make decisions about their lifestyles. Comments included, I choose how I spend my time and try to keep my mind and body as active as possible, and, The staff know me well, but still ask me how I want things to be done. Relatives advocate on behalf of their family member where this is needed due to mental frailty, and information on advocacy services is available. People are encouraged to bring possessions from home to personalise their bedroom. Wherever possible they keep control of their personal finances and financial care plans are recorded that show the extent of support that individuals need. People can access their personal care records and are involved in the assessment process and individual care review meetings. The home has a three week cycle of menus. Breakfast consists of fruit juice, Care Homes for Older People Page 17 of 31 Evidence: grapefruit, cereals, toast, fresh fruit and cooked items daily. Lunch is a fruit juice starter, and choice of main meal followed by dessert. Home-made cakes, scones, buns, or fruit loaf are served with afternoon tea. The evening meal is soup, a choice of lighter meal or sandwiches and dessert. A range of snacks are provided for supper. The inspector took lunch with people living at the home. The dining tables were nicely set and condiments were available. Hot and cold drinks were offered. The meal was a choice of smoked haddock or gammon with potatoes and vegetables, followed by rice pudding. A sugar free version of the pudding was provided for people with diabetes. Staff used to ask people their choice of meal and record this on preferences sheets. This has been changed because they found people tended to forget what they had chosen. While people are still informed what is on the menu, they are now shown the different meals at the time to make their choice. People said they enjoyed the meal and some gave compliments directly to the cook. A staff member was observed sitting with a lady to assist her to eat the meal. She spoke reassuringly to her and gave good support and encouragement. Some issues from meal times and comments from surveys about the food were discussed with the manager. These were that a staff member stood over a lady whilst assisting her to eat lunch. A soft diet for one person had all the food items mixed together, as opposed to being presented separately. At the evening meal people were handed bread from a tray to go with soup and there were no side plates for it to be served on. The majority of people said they usually like the meals. Comments included, The food is very good, and, They are very good in providing fresh fruit for me in place of the puddings which I never eat. One person said there is too much sausage and corned beef in the menus. Another said the choice and variety of puddings for people who are diabetic is limited. A relative said her mother complains the food is not hot enough much of the time. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints procedure that people understand and staff are trained to protect vulnerable people from being harmed. Evidence: The complaints procedure is included in the welcome pack that is provided in each persons bedroom. People living at the home said they know how to make a complaint. One person said, I believe it is written in the service user guide, where I would look if necessary. Staff said they know what to do if anyone has concerns about the service. A staff member said, There is a policy to follow and I would always report concerns. A file is maintained for records of complaints and compliments. One complaint was recorded in the past year. The homes area manager had responded to this appropriately and offered an apology for a breakdown in communication. The home has a range of policies and procedures on recognising and preventing abuse, safeguarding vulnerable adults and whistle blowing (informing on bad practice). Staff are provided with protection training. One safeguarding alert was raised since the previous inspection. This was reported promptly to the relevant authorities and did not involve alleged abuse by staff. Care Homes for Older People Page 19 of 31 Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clean, attractive and well maintained accommodation is provided for the comfort of the people living at the home. Evidence: All parts of the building are attractively decorated and furnished and aids and equipment are provided to meet peoples needs. There are comfortable communal areas, and lounges have nice touches such as fresh flowers, and fresh fruit and sweets in bowls. Bedrooms are personalised with individuals possessions and have colour coordinated curtains and bed linen. Information on the homes services is kept in each bedroom for people to refer to. The gardens are well kept and some people said they enjoy sitting out in fine weather. In the period since the last inspection a number of improvements have been made to the environment. The conservatory has a a new roof and is refurbished with new flooring and furniture. New lounge and dining room furniture has been provided. There is now an internal front porch. The office space is extended. A sluicing facility is installed. New tables, lamps and pictures were purchased to make areas more homely. Audits of the building are carried out to make sure it is properly maintained and there is an ongoing programme of redecoration and maintenance. Plans for the coming year Care Homes for Older People Page 21 of 31 Evidence: include replacing some bedroom furniture and carpets, and installing a water feature in the garden with a walk way and seating area. Policies and procedures are in place for control of infection, and staff receive relevant training. Protective equipment such as disposable gloves and aprons are provided. There are suitable hand washing facilities throughout the building. The home has arrangements to dispose of clinical waste. The manager is arranging for ventilation in the sluice to be checked, as this was not working properly. She is also to remind staff that the sluice door must always be locked as cleaning chemicals are kept here. All areas of the home were clean and free from odours. The majority of people said the home is always fresh and clean. Comments included, The home is very clean indeed, and, It is a very pleasant place to be in. One person indicated they find the main lounge too hot and stuffy, and said visitors had commented on odour in the corridors. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of care workers who are provided with good training to make sure they are skilled in meeting peoples diverse needs. Evidence: People who completed surveys said staff are always or usually available when they need them, and listen and act on what they say. They said, On a few occasions when we have visited there has seemed to be insufficient staff to deal with everybody, There is a tendency for staff to forget what you have requested, My mother feels the staff are sometimes too busy to see to everyones needs, They are frequently short staffed, which means waiting until someone is available. We are currently without a manager, and although the deputy manager is very good she naturally has to have days off and is not always available, and, The team leaders and management staff are all excellent. People spoken with during the inspection said there is sufficient staff to meet their needs. Most staff said there is usually enough staff to meet the individual needs of all the people living at the home. Two said that levels can be reduced due to short notice sickness absence and one indicated that in this event senior staff do their best get cover. Care Homes for Older People Page 23 of 31 Evidence: At the time of the inspection there was 29 people living at the home. Rotas showed that staffing levels of five care staff across the waking day and three at night are provided. A team leader is designated in charge of the home on each shift when the manager is not on duty. There are appropriate weekly catering, domestic and laundry hours and a handy person and gardener is employed. On the day of the inspection there was an extra carer on duty to accompany a person to a hospital appointment. Comments about staffing were discussed with the manager. She said rotas are monitored and an additional carer is now provided in the evenings. She acknowledged there has been a few occasions of short notice absence though said staff are usually very good at providing cover and more bank staff are being employed. 19 of the 24 carers have achieved National Vocational Qualifications (NVQ) in care at either Levels 2 or 3. One staff member is studying for this qualification. Staff told us employment checks were carried out before they started work and that they received good induction training. One staff member suggested additional hours as extra to the rota could be provided during induction. The manager said the home aims to give new carers a full week during induction when they are not counted in with the staffing levels. There were two staff vacancies for team leaders and these were being advertised. A sample of staff recruitment files was examined. These contained photograph, proof of identification, application forms with details of employment history and references from suitable sources including the persons last employer. There was no declaration of fitness statement in any of the files and two people did not have records of interview. All staff are employed subject to Criminal Records Bureau (CRB) checks being carried out. Individual staff training records and certificates are kept. The home also maintains a training matrix that gives an overview of each staff members completed and planned training. In the past year raining has been provided on first aid, moving and handling, fire safety, food hygiene, health and safety, use of the mobile hoist, medication, protection of vulnerable adults, infection control, podiatry, and nutrition. Further training was being organised. The home continues to provide staff with in-house training sessions on different policies and procedures and care practices. Recent sessions include assisting people to bathe, go to bed and use the toilet, and incorporate role play. All staff told us they are given training that is relevant to their role, helps them understand and meet individuals needs and keeps them up to date with new ways of Care Homes for Older People Page 24 of 31 Evidence: working. Some staff gave comments on what they think the service does well. They said, If staff have any problems they can go to seniors or the manager to discuss things and are given any assistance needed. The residents are treated as you would expect to treat members of your own family, and, We care for the residents to a high standard. There is good training. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the home is managed in peoples best interests, clear aims to ensure a quality service are still being developed and the fire safety system is not fully robust. Evidence: The Registered Manager left employment in 2008 and the deputy manager has been managing the home since this time. She has worked at the home since 2003 and has National Vocational Qualifications in care at levels 2 and 3. She is studying for level 4 and upon completion intends to undertake the Registered Manager Award course. The acting manager has 24 hours management time weekly. She said she is well supported in her role by senior staff, managers from other homes within the company and area management. The provider company, Wellburn Care Homes has an accredited quality assurance system. Methods are in place to monitor and improve the quality of the service at the Care Homes for Older People Page 26 of 31 Evidence: home. These include audits, surveys, and resident and relative meetings. An annual quality plan that sets out the range of methods used and measurable outcomes has not been developed, as recommended at the previous inspection. An area manager carries out monthly visits and reports on the conduct of the home. This covers occupancy, employees, activities, environment, food and service, records of training, health and safety, and complaints, and discussion with residents, staff, and visitors. Copies of some reports from recent months were not available in the home. People have personal finance care plans. Cash is held for safe keeping and a record is kept of individuals accounts. Transactions were appropriately recorded and numbered receipts are kept for purchases. There are regular checks of cash and balances. The home has a health and safety policy and procedures. Staff are provided with health and safety training and regular updates of safe working practices training. Risk assessments are carried out to make sure there are safe systems of work in place. Fire safety records showed that checks of emergency lighting and fire fighting equipment are done at the correct intervals. Whilst weekly fire alarm tests were now being recorded, there was a gap of five months when tests were not documented as being carried out. Fire instructions to staff are not forward planned and the records did not demonstrate these as provided at the frequency of three monthly for night staff and six monthly for day staff. There is a system for accident reporting and the manager does an analysis of accidents to make sure follow up action is taken where needed. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 23 Staff must be provided with 25/04/2009 fire safety instructions at the required frequency. Fire alarms tests must be carried out weekly. To make sure staff have up to date knowledge of what to do in the event of a fire, and that fire safety tests are kept up to date. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Each person should have a pre-admission assessment of their needs carried out before moving into the home. Outstanding from previous inspection. Staff should make sure all prescribed medication given to people is signed for, or enter the appropriate code to state the reason why it was not given. Staff should make sure they only sign for medication that is given to people. Comments from people living at the home about the food and observations of meal time practices should be Page 29 of 31 2 9 3 15 Care Homes for Older People addressed. 4 29 A declaration statement of fitness to do the job should be introduced to the staff recruitment process. Records of staff being interviewed should be kept. Application should be made to the Commission to register a suitably experienced and qualified person to manage the home. An annual quality plan should be developed that incorporates all methods of monitoring the quality of the service. Outstanding from previous inspection. 5 31 6 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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